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Revamp of practice-based commissioning 'not enough'

By Gareth Iacobucci

A leading advisor to Lord Darzi has criticised the minister's NHS Next State Review for failing to do enough to salvage practice-based commissioning.

Lord Darzi's report pledged to ‘redefine and reinvigorate' the flagging health policy, with incentives to encourage a broader range of clinicians to become involved, and tougher scrutiny over the support provided by PCTs.

Under the plans, PBC groups will be entitled to improved budgetary information and financial support from PCTs, and will be handed ‘increased freedoms in managing resources and designing services'.

But the report stopped short of guaranteeing GPs real budgets, and was criticised for being potentially bureaucratic.

Dr Michael Dixon, chair of the NHS Alliance and a member of Lord Darzi's advisory panel, said that the good ideas put forward may be held back by ‘another managerial hierarchy'.

He said: ‘Conceptually it's fairly radical, but a radical strategy may not change the world.

‘What worries me is quite how much of it is being put into the hands of SHAs, who are recognisably clinically deficient.

‘Simply putting in a clinical director won't make SHAs locally sensitive. I'm worried we may get a new form of centralism that's simply devolved at SHA level.'

Dr Dixon had tabled proposals to trial model PBC practices, one in each SHA, to be given concrete budgets for a range of services.

Dr James Kingsland, another advisor to Lord Darzi and chair of the NAPC, said rhetoric had to be supported by ‘hard cash', with GP commissioners measured on outcomes like length of hospital stay and re-admissions.

He warned: ‘Major transformation of a health service can't be done on a shoestring. It's not a case of "we'll only do it for a bit of money", but there's no point in the rhetoric just being about good will.'

Dr Mike Dixon

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